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Incidence of severe critical events in paediatric anaesthesia (APRICOT) : a prospective multicentre observational study in 261 hospitals in Europe

(2017) LANCET RESPIRATORY MEDICINE. 5(5). p.412-425
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Abstract
Background: Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods: The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings: Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6.35 years (SD 4.50) were included. The incidence of perioperative severe critical events was 5.2% (95% CI 5.0-5.5) with an incidence of respiratory critical events of 3.1% (2.9-3.3). Cardiovascular instability occurred in 1.9% (1.7-2.1), with an immediate poor outcome in 5.4% (3.7-7.5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0.88, 95% CI 0.86-0.90; p<0.0001), medical history, and physical condition (1.60, 1.40-1.82; p<0.0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0.99, 0.981-0.997; p<0.0048 for respiratory critical events, and 0.98, 0.97-0.99; p=0.0039 for cardiovascular critical events), rather than the type of health institution or providers. Interpretation: This study highlights a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist societies to target education of anaesthesiologists and their teams and implement strategies for quality improvement in paediatric anaesthesia.
Keywords
RESPIRATORY ADVERSE EVENTS, CARDIAC-ARREST, RISK-FACTORS, REGIONAL, ANESTHESIA, PROSPECTIVE COHORT, OPERATING-ROOM, CHILDREN, COMPLICATIONS, MORBIDITY, SYSTEM

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MLA
Habre, Walid, et al. “Incidence of Severe Critical Events in Paediatric Anaesthesia (APRICOT) : A Prospective Multicentre Observational Study in 261 Hospitals in Europe.” LANCET RESPIRATORY MEDICINE, vol. 5, no. 5, 2017, pp. 412–25, doi:10.1016/S2213-2600(17)30116-9.
APA
Habre, W., Disma, N., Virag, K., Becke, K., Hansen, T. G., Joehr, M., … Zunser, I. (2017). Incidence of severe critical events in paediatric anaesthesia (APRICOT) : a prospective multicentre observational study in 261 hospitals in Europe. LANCET RESPIRATORY MEDICINE, 5(5), 412–425. https://doi.org/10.1016/S2213-2600(17)30116-9
Chicago author-date
Habre, Walid, Nicola Disma, Katalin Virag, Karin Becke, Tom G Hansen, Martin Joehr, Brigitte Leva, et al. 2017. “Incidence of Severe Critical Events in Paediatric Anaesthesia (APRICOT) : A Prospective Multicentre Observational Study in 261 Hospitals in Europe.” LANCET RESPIRATORY MEDICINE 5 (5): 412–25. https://doi.org/10.1016/S2213-2600(17)30116-9.
Chicago author-date (all authors)
Habre, Walid, Nicola Disma, Katalin Virag, Karin Becke, Tom G Hansen, Martin Joehr, Brigitte Leva, Neil S Morton, Petronella M Vermeulen, Marzena Zielinska, Krisztina Boda, Francis Veyckemans, Walter Klimscha, Regina Konecny, Robert Luntzer, Ulrike Morawk-Wintersperger, Franz Neiger, Lydia Rustemeyer, Christian Breschan, Denise Frey, Manuela Platzer, Reinhard Germann, Joachim Oeding, Birgit Stoegermuller, Bernhard Ziegler, Philipp Brotatsch, Anton Gutmann, Gerlinde Mausser, Brigitte Messerer, Wolfgang Toller, Maria Vittinghoff, Gregor Zangl, Natascha Seidel-Ahyai, Christoph Hochhold, Ruth Kroess, Peter Paal, Steven Cnudde, Patricia Coucke, Birgit Loveniers, John Mitchell, David Kahn, Thierry Pirotte, Caroline Pregardien, Francis Veyckemans, Marc Coppens, Luc De Baerdemaeker, Stefan De Hert, Bjorn Heyse, Martine Neckebroek, Aliaksandra Parashchanka, Jurgen van Limmen, Nancy Van Den Eynde, Caroline Vanpeteghem, PIET WYFFELS, Michael Lalot, Jean-Paul Lechat, France Stevens, Sari Casaer, Francoise De Groote, Francoise De Pooter, Andree De Ville, Marc Gerin, Natalia Magasich, Cristel Sanchez Torres, Denise Van Deenen, Johan Berghmans, Dirk Himpe, Eva Roofthooft, Ellen Joukes, Carine Smitz, Veronique Van Reeth, Christel Huygens, Julie Lauweryns, Karen De Smet, Nadia Najafi, Jan Poelaert, Anne Van de Velde, Veerle Van Mossevelde, Ivan Bekavac, Diana Butkovic, Dubravka Heli Litvic, Ivana Kerovec Soric, Hrvoje Maretic, Djurdjica Moscatello, Ljiljana Popovic, Slobodan Micic, Ivana Stuck Tus, Lada Kalagac Fabris, Tatjana Simurina, Nina Sulen, Gordana Kesi-Valpotic, Dajana Djapic, Jiri Zurek, Lucie Jureckova, Iveta Mackova, Monika Skacel, Stanislava Weinlichova, Jan Divak, Michal Frelich, Rene Urbanec, Vera Biskupova, Vladimir Mixa, Jana Pavlickova, Arash Afshari, Morten Bottger, Marguerite B Ellekvist, Mathias Johansen, Birgitte Ingeborg Madsen, Jens Christian Nilsson, Birgitte MB Schousboe, Nicola G Clausen, Tom G Hansen, Nick Phaff Steen, Mari-Liis Ilmoja, Virge Tonise, Juri Karjagin, Reet Kikas, Mika Isohanni, Anniina Lyly, Annika Takala, Johanna Happo, Kai Kiviluoma, Kati Martikainen, Riku Aantaa, Tuula Manner, Sanna Vilo, Catherine Amory, Hugues Ludot, Patricia Lambotte, Rene Busche, Olivier Jacqmarcq, Corinne Lejus, Julien Corouge, Christian Erb, Delphine Garrigue, Patricia Gillet, Anne Laffargue, Veronique Lambelin, Helene Le Freche, Daliana Peresbota, Pierre Richart, Jerome Berton, Catherine Chapotte, Laurent Colbus, Thierry Lehousse, Jean Monrigal, Catherine Baujard, Philippe Roulleau, Giuseppe Staiti, Helene Batoz, Maryline Bordes, Anne Didier, Yann Hamonic, Sylvaine Lagarde, Karine Nouette-Gaulain, Francois Semjen, Brigitte Zaghet, Jacky Dekens, Axelle Delcuze, Herve Dupont, Aurelien Legrand, Celine Raffoflandreur, Noemie Audren, Blandine Camus, Marielle Cartal, Chantal Chazelet, Isabelle Davin, Marion Guillier, Luc Desjeux, Claire Larcher, Elodie Grein, Mickeal Leclercq, Roxana Levitchi, Lilica Rosu, Dominique Simon, Aurelien Zang, Anne Migeon, Anne-Charlotte Gagey, Nathalie Bourdaud, Anne-Charlotte Carre, Frederic Duflo, Jean-Claude Riche, Philippe Robert, Emilie Druot, Olivier Maupain, Gilles Orliaguet, Lucie Sabau, Hanna Taright, Lynn Uhrig, Juliette Verchere-Montmayeur, Lise Debrabant, Clotaire Pilla, Alexandre Podvin, Benjamin Roth, Souhayl Dahmani, Florence Julien-Marsollier, Nada Sabourdin, Bogdan Alexandri, Gilles Brezac, Francois de la Briere, Catherine Hayem, Elizabeth Lhubat, Jean Paul Mission, Charlotte Remond, Christophe Dadure, Maud Maniora, Anais Marie, Philippe Pirat, Anne-Charlotte Saour, Chrystelle Sola, Claude Ecoffey, Eric Wodey, Christian Adam, Thomas Standl, Ehrenfried Schindler, Tomohiro Yamamoto, Michael Brackhahn, Christoph Bernhard Eich, Holger Guericke, Petra Kindermann, Michael Laschat, Cornel Schink, Frank Wappler, Claudia Hoehne, Natalia Skordou, Johanna Ulrici, Martin Jetzek-Zader, Peter Kienbaum, Tanja Meyer-Treschan, Olaf Picker, Maximilian S Schaefer, Golo Mielke, Sabine Baethge, Axel Ramminger, Martin Bauer, Matthias Bollinger, Jose Hinz, Michael Quintel, Sebastian G Russo, Michael Bauer, Dfominik Geil, Andreas Kortgen, Niels-Peter Preussler, Ulrich Hofmann, Manfred Raber, Doris Reindl, Karin Becke, Karin Oppenrieder, Bettina Schierlinger, Jens Roth, Wolfgang Funk, Thomas Fischer, Christian Gernoth, Christina Wiefelsputz, Hauke Volger, Nicole Zederer, Anja Diers, Matthias Huber, Clemens Schorer, Andreas Weyland, Konrad Schwarzkopf, Catharina Grau, Winfried Roth, Rolf Holy, Thomas Mader, Laura Peter, Hauke Supthut, Thomas Kuehhirt, Alexander Milde, Fritz Fiedler, Carsten Isselhorst, Ulrich Grundmann, Alexander Pattar, Jennifer Reinert, Birgit Ehm, Katrin Fritzsche, Ralf Gaebler, Patrick Meybohm, Maximilian Hein, Ines Guzman, Johanna Jokinen, Peter Kranke, Ulrich Goebel, Sarah Harris, Christoph Eisner, Miriam Ochsenreiter, Michael Schoeler, Elke Thil, Richard Ellerkmann, Andreas Hoeft, Claudia Neumann, Stefan Weber, Julia Keilhauer, Jan Kloessing, Michael Schramm, Uwe Trieschmann, Kristina Knauss, Barbara Sinner, Johannes Steinmann, Herbert Koessler, Evagelia Kalliardou, Anna Malisiova, Adelais Tsiotou, Pelagia Chloropoulou, Mpratzou Chrysi, Despoina Iordanidou, Merkourios Ntavlis, Ferenc Rarosi, Krisztina B Boda, Christilynn Guerin, Janice Irwin, Claire Magner, Solmaz Nakhjavani, Brendan O’Hare, Deborah Galvin, Yosry Jamil, Carlos Lesmes, Yuri Barak, Haran Fisher, Ludmyla Kachko, Jacob Katz, Dmitry Kirilov, Michael Levinzon, Yair Manevich, Konstantin Nekrasov, Elia Peled, Elena Sanko, Dmitri Schmain, Olga Sheinkin, Eliahu Simhi, Alex Tarabikin, Evelina Trabkin, Irena Yagudaev, Yelena Zeitlin, and Igor Zunser. 2017. “Incidence of Severe Critical Events in Paediatric Anaesthesia (APRICOT) : A Prospective Multicentre Observational Study in 261 Hospitals in Europe.” LANCET RESPIRATORY MEDICINE 5 (5): 412–425. doi:10.1016/S2213-2600(17)30116-9.
Vancouver
1.
Habre W, Disma N, Virag K, Becke K, Hansen TG, Joehr M, et al. Incidence of severe critical events in paediatric anaesthesia (APRICOT) : a prospective multicentre observational study in 261 hospitals in Europe. LANCET RESPIRATORY MEDICINE. 2017;5(5):412–25.
IEEE
[1]
W. Habre et al., “Incidence of severe critical events in paediatric anaesthesia (APRICOT) : a prospective multicentre observational study in 261 hospitals in Europe,” LANCET RESPIRATORY MEDICINE, vol. 5, no. 5, pp. 412–425, 2017.
@article{8557695,
  abstract     = {{Background: Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. 
Methods: The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. 
Findings: Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6.35 years (SD 4.50) were included. The incidence of perioperative severe critical events was 5.2% (95% CI 5.0-5.5) with an incidence of respiratory critical events of 3.1% (2.9-3.3). Cardiovascular instability occurred in 1.9% (1.7-2.1), with an immediate poor outcome in 5.4% (3.7-7.5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0.88, 95% CI 0.86-0.90; p<0.0001), medical history, and physical condition (1.60, 1.40-1.82; p<0.0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0.99, 0.981-0.997; p<0.0048 for respiratory critical events, and 0.98, 0.97-0.99; p=0.0039 for cardiovascular critical events), rather than the type of health institution or providers. 
Interpretation: This study highlights a relatively high rate of severe critical events during the anaesthesia management of children for surgical or diagnostic procedures in Europe, and a large variability in the practice of paediatric anaesthesia. These findings are substantial enough to warrant attention from national, regional, and specialist societies to target education of anaesthesiologists and their teams and implement strategies for quality improvement in paediatric anaesthesia.}},
  author       = {{Habre, Walid and Disma, Nicola and Virag, Katalin and Becke, Karin and Hansen, Tom G and Joehr, Martin and Leva, Brigitte and Morton, Neil S and Vermeulen, Petronella M and Zielinska, Marzena and Boda, Krisztina and Veyckemans, Francis and Klimscha, Walter and Konecny, Regina and Luntzer, Robert and Morawk-Wintersperger, Ulrike and Neiger, Franz and Rustemeyer, Lydia and Breschan, Christian and Frey, Denise and Platzer, Manuela and Germann, Reinhard and Oeding, Joachim and Stoegermuller, Birgit and Ziegler, Bernhard and Brotatsch, Philipp and Gutmann, Anton and Mausser, Gerlinde and Messerer, Brigitte and Toller, Wolfgang and Vittinghoff, Maria and Zangl, Gregor and Seidel-Ahyai, Natascha and Hochhold, Christoph and Kroess, Ruth and Paal, Peter and Cnudde, Steven and Coucke, Patricia and Loveniers, Birgit and Mitchell, John and Kahn, David and Pirotte, Thierry and Pregardien, Caroline and Veyckemans, Francis and Coppens, Marc and De Baerdemaeker, Luc and De Hert, Stefan and Heyse, Bjorn and Neckebroek, Martine and Parashchanka, Aliaksandra and van Limmen, Jurgen and Van Den Eynde, Nancy and Vanpeteghem, Caroline and WYFFELS, PIET and Lalot, Michael and Lechat, Jean-Paul and Stevens, France and Casaer, Sari and De Groote, Francoise and De Pooter, Francoise and De Ville, Andree and Gerin, Marc and Magasich, Natalia and Torres, Cristel Sanchez and Van Deenen, Denise and Berghmans, Johan and Himpe, Dirk and Roofthooft, Eva and Joukes, Ellen and Smitz, Carine and Van Reeth, Veronique and Huygens, Christel and Lauweryns, Julie and De Smet, Karen and Najafi, Nadia and Poelaert, Jan and Van de Velde, Anne and Van Mossevelde, Veerle and Bekavac, Ivan and Butkovic, Diana and Litvic, Dubravka Heli and Soric, Ivana Kerovec and Maretic, Hrvoje and Moscatello, Djurdjica and Popovic, Ljiljana and Micic, Slobodan and Tus, Ivana Stuck and Fabris, Lada Kalagac and Simurina, Tatjana and Sulen, Nina and Kesi-Valpotic, Gordana and Djapic, Dajana and Zurek, Jiri and Jureckova, Lucie and Mackova, Iveta and Skacel, Monika and Weinlichova, Stanislava and Divak, Jan and Frelich, Michal and Urbanec, Rene and Biskupova, Vera and Mixa, Vladimir and Pavlickova, Jana and Afshari, Arash and Bottger, Morten and Ellekvist, Marguerite B and Johansen, Mathias and Madsen, Birgitte Ingeborg and Nilsson, Jens Christian and Schousboe, Birgitte MB and Clausen, Nicola G and Hansen, Tom G and Steen, Nick Phaff and Ilmoja, Mari-Liis and Tonise, Virge and Karjagin, Juri and Kikas, Reet and Isohanni, Mika and Lyly, Anniina and Takala, Annika and Happo, Johanna and Kiviluoma, Kai and Martikainen, Kati and Aantaa, Riku and Manner, Tuula and Vilo, Sanna and Amory, Catherine and Ludot, Hugues and Lambotte, Patricia and Busche, Rene and Jacqmarcq, Olivier and Lejus, Corinne and Corouge, Julien and Erb, Christian and Garrigue, Delphine and Gillet, Patricia and Laffargue, Anne and Lambelin, Veronique and Le Freche, Helene and Peresbota, Daliana and Richart, Pierre and Berton, Jerome and Chapotte, Catherine and Colbus, Laurent and Lehousse, Thierry and Monrigal, Jean and Baujard, Catherine and Roulleau, Philippe and Staiti, Giuseppe and Batoz, Helene and Bordes, Maryline and Didier, Anne and Hamonic, Yann and Lagarde, Sylvaine and Nouette-Gaulain, Karine and Semjen, Francois and Zaghet, Brigitte and Dekens, Jacky and Delcuze, Axelle and Dupont, Herve and Legrand, Aurelien and Raffoflandreur, Celine and Audren, Noemie and Camus, Blandine and Cartal, Marielle and Chazelet, Chantal and Davin, Isabelle and Guillier, Marion and Desjeux, Luc and Larcher, Claire and Grein, Elodie and Leclercq, Mickeal and Levitchi, Roxana and Rosu, Lilica and Simon, Dominique and Zang, Aurelien and Migeon, Anne and Gagey, Anne-Charlotte and Bourdaud, Nathalie and Carre, Anne-Charlotte and Duflo, Frederic and Riche, Jean-Claude and Robert, Philippe and Druot, Emilie and Maupain, Olivier and Orliaguet, Gilles and Sabau, Lucie and Taright, Hanna and Uhrig, Lynn and Verchere-Montmayeur, Juliette and Debrabant, Lise and Pilla, Clotaire and Podvin, Alexandre and Roth, Benjamin and Dahmani, Souhayl and Julien-Marsollier, Florence and Sabourdin, Nada and Alexandri, Bogdan and Brezac, Gilles and de la Briere, Francois and Hayem, Catherine and Lhubat, Elizabeth and Mission, Jean Paul and Remond, Charlotte and Dadure, Christophe and Maniora, Maud and Marie, Anais and Pirat, Philippe and Saour, Anne-Charlotte and Sola, Chrystelle and Ecoffey, Claude and Wodey, Eric and Adam, Christian and Standl, Thomas and Schindler, Ehrenfried and Yamamoto, Tomohiro and Brackhahn, Michael and Eich, Christoph Bernhard and Guericke, Holger and Kindermann, Petra and Laschat, Michael and Schink, Cornel and Wappler, Frank and Hoehne, Claudia and Skordou, Natalia and Ulrici, Johanna and Jetzek-Zader, Martin and Kienbaum, Peter and Meyer-Treschan, Tanja and Picker, Olaf and Schaefer, Maximilian S and Mielke, Golo and Baethge, Sabine and Ramminger, Axel and Bauer, Martin and Bollinger, Matthias and Hinz, Jose and Quintel, Michael and Russo, Sebastian G and Bauer, Michael and Geil, Dfominik and Kortgen, Andreas and Preussler, Niels-Peter and Hofmann, Ulrich and Raber, Manfred and Reindl, Doris and Becke, Karin and Oppenrieder, Karin and Schierlinger, Bettina and Roth, Jens and Funk, Wolfgang and Fischer, Thomas and Gernoth, Christian and Wiefelsputz, Christina and Volger, Hauke and Zederer, Nicole and Diers, Anja and Huber, Matthias and Schorer, Clemens and Weyland, Andreas and Schwarzkopf, Konrad and Grau, Catharina and Roth, Winfried and Holy, Rolf and Mader, Thomas and Peter, Laura and Supthut, Hauke and Kuehhirt, Thomas and Milde, Alexander and Fiedler, Fritz and Isselhorst, Carsten and Grundmann, Ulrich and Pattar, Alexander and Reinert, Jennifer and Ehm, Birgit and Fritzsche, Katrin and Gaebler, Ralf and Meybohm, Patrick and Hein, Maximilian and Guzman, Ines and Jokinen, Johanna and Kranke, Peter and Goebel, Ulrich and Harris, Sarah and Eisner, Christoph and Ochsenreiter, Miriam and Schoeler, Michael and Thil, Elke and Ellerkmann, Richard and Hoeft, Andreas and Neumann, Claudia and Weber, Stefan and Keilhauer, Julia and Kloessing, Jan and Schramm, Michael and Trieschmann, Uwe and Knauss, Kristina and Sinner, Barbara and Steinmann, Johannes and Koessler, Herbert and Kalliardou, Evagelia and Malisiova, Anna and Tsiotou, Adelais and Chloropoulou, Pelagia and Chrysi, Mpratzou and Iordanidou, Despoina and Ntavlis, Merkourios and Rarosi, Ferenc and Boda, Krisztina B and Guerin, Christilynn and Irwin, Janice and Magner, Claire and Nakhjavani, Solmaz and O'Hare, Brendan and Galvin, Deborah and Jamil, Yosry and Lesmes, Carlos and Barak, Yuri and Fisher, Haran and Kachko, Ludmyla and Katz, Jacob and Kirilov, Dmitry and Levinzon, Michael and Manevich, Yair and Nekrasov, Konstantin and Peled, Elia and Sanko, Elena and Schmain, Dmitri and Sheinkin, Olga and Simhi, Eliahu and Tarabikin, Alex and Trabkin, Evelina and Yagudaev, Irena and Zeitlin, Yelena and Zunser, Igor}},
  issn         = {{2213-2600}},
  journal      = {{LANCET RESPIRATORY MEDICINE}},
  keywords     = {{RESPIRATORY ADVERSE EVENTS,CARDIAC-ARREST,RISK-FACTORS,REGIONAL,ANESTHESIA,PROSPECTIVE COHORT,OPERATING-ROOM,CHILDREN,COMPLICATIONS,MORBIDITY,SYSTEM}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{412--425}},
  title        = {{Incidence of severe critical events in paediatric anaesthesia (APRICOT) : a prospective multicentre observational study in 261 hospitals in Europe}},
  url          = {{http://doi.org/10.1016/S2213-2600(17)30116-9}},
  volume       = {{5}},
  year         = {{2017}},
}

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